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Healthcare Claims Management Jobs (NOW HIRING)

Independent Living Systems

Claims Auditor

Miami, FL · On-site

By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors. Ultimately, this role supports the delivery ...

System One

Healthcare Claims Specialist

Tulsa, OK · On-site

$18 - $20/hr

Healthcare Claims Specialist (CONTRACT Opportunity) Downtown Tulsa, OK Monday-Friday | 8:00 AM - 5:00 PM | Onsite Project Assignment Through March 2027 - IMMEDIATE START Pay rate DOE: $18-20/hr.

LSMA Management Inc

Claims Manager

San Bernardino, CA · On-site

$87K - $97K/yr

Bachelor's degree in Healthcare Administration, Business Administration, or related field. Experience Minimum: At least five years of managed care claims processing experience. Two or more years of ...

KARNA LLC

$22 - $25/hr

Analyze and report on trends in claim issues or irregularities to management, contributing to ... Understanding of medical terminology, healthcare services, and insurance procedures (worker ...

Karna, LLC

$20 - $25/hr

Analyze and report on trends in claim issues or irregularities to management, contributing to ... Understanding of medical terminology, healthcare services, and insurance procedures (worker ...

Firstsource

Claims Examiner

$17 - $20/hr

Experience in Managed Care, Health Insurance, Third-Party Administration (TPA), or Healthcare ... Claims Processing * Appeals & Grievance Administration * Claims Investigation * Healthcare ...

Firstsource

Claims Examiner

$17 - $20/hr

Experience in Managed Care, Health Insurance, Third-Party Administration (TPA), or Healthcare ... Claims Processing * Appeals & Grievance Administration * Claims Investigation * Healthcare ...

System One

Healthcare EDI Claims Analyst

Columbia, MD · On-site

$52.96/hr

Healthcare EDI Claims Analyst Location: Hybrid - Columbia/Baltimore, MD (2-3 days onsite per month ... Incident/ticket management experience. * Basic SQL skills for querying and analyzing data.

GDIT

Healthcare Claims Data Analyst

WV · Remote

Managing several concurrent requests against firm deadlines within a queue driven by Partner and ... Experience with healthcare claims data (Medicare, Medicaid or commercial) and healthcare coding ...

MMC Group LP

Be Seen First

URGENT - Claims Resolution Associate

Helena, MT · On-site

$18 - $20/hr

Familiarity with healthcare claims review, adjudication, or Medicaid regulations * Experience using claims management systems or Electronic Health Record (EHR) platforms preferred * Knowledge of ...

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Healthcare Claims Management information

See salary details

$35K

$87.9K

$139K

How much do healthcare claims management jobs pay per year?

As of Aug 17, 2026, the average yearly pay for healthcare claims management in the United States is $87,861.00, according to ZipRecruiter salary data. Most workers in this role earn between $68,000.00 and $105,000.00 per year, depending on experience, location, and employer.

What is healthcare claims management?

Healthcare claims management is the process of handling medical insurance claims, from submission to reimbursement. It involves reviewing, processing, and following up on claims sent to insurance companies by healthcare providers. The goal is to ensure that providers are accurately paid for services rendered and that patients' insurance benefits are correctly applied. Effective claims management helps reduce denials, improve cash flow, and minimize administrative errors in healthcare billing.

What are the key skills and qualifications needed to thrive in healthcare claims management?

To thrive in Healthcare Claims Management, you need a solid understanding of medical billing, insurance policies, coding systems (such as ICD-10 and CPT), and typically a relevant associate’s or bachelor’s degree. Familiarity with claims processing software, electronic health record (EHR) systems, and regulatory compliance tools is essential. Strong attention to detail, analytical thinking, and effective communication help you resolve discrepancies and interact with providers and payers. These skills are crucial for ensuring accurate claims processing, minimizing denials, and maintaining efficient revenue cycles in healthcare organizations.

What are some common challenges faced in healthcare claims management, and how can professionals effectively address them?

Healthcare claims management professionals often encounter challenges such as processing complex claims, navigating frequent regulatory changes, and handling denied or delayed claims. To address these issues, professionals must stay updated on the latest healthcare regulations and payer requirements and develop strong attention to detail when reviewing documentation. Collaborating closely with billing teams and insurance providers, as well as using advanced claims management software, can help streamline workflows and reduce errors, ultimately improving the accuracy and efficiency of claims processing.

What is the difference between Healthcare Claims Management vs Medical Billing Specialist?

AspectHealthcare Claims ManagementMedical Billing Specialist
CredentialsTypically requires knowledge of insurance policies, coding, and claims processing; certifications like CPC or CCS are commonRequires coding and billing knowledge; certifications like CPC are often preferred
Work EnvironmentOften in healthcare offices, insurance companies, or claims processing centersPrimarily in medical offices, hospitals, or billing companies
Job FocusManaging and processing insurance claims, resolving claim denials, ensuring compliancePreparing and submitting patient bills, coding procedures, and following up on payments
Industry UsageUsed across healthcare providers, insurance companies, and third-party administratorsPrimarily used within healthcare providers' billing departments

While both roles involve billing and coding, Healthcare Claims Management focuses on overseeing the entire claims process, including denials and compliance, whereas Medical Billing Specialists handle the day-to-day billing and coding tasks for patient accounts.

Is healthcare claims management a stressful job?

Healthcare claims management can be stressful due to the need for accuracy, meeting deadlines, and handling complex insurance policies. The role often requires attention to detail, strong organizational skills, and the ability to manage high workloads, especially during busy periods or audits.
More about Healthcare Claims Management jobs

What cities are hiring for Healthcare Claims Management jobs?

Cities with the most Healthcare Claims Management job openings:

What states have the most Healthcare Claims Management jobs?

States with the most job openings for Healthcare Claims Management jobs include:

What job categories do people searching Healthcare Claims Management jobs look for?

The top searched job categories for Healthcare Claims Management jobs are:

Healthcare Claims Management jobs near you
Infographic showing various Healthcare Claims Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $87,861 per year, or $42.2 per hour.

Claims Auditor

Independent Living Systems

Miami, FL • On-site

Full-time

Re-posted 17 days ago

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Claims Auditor to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Claims Auditor plays an essential role in ensuring the accuracy, compliance, and integrity of health care claims within the organization. This position involves conducting thorough audits of submitted claims to verify adherence to regulatory standards, contractual obligations, and internal policies. The Claims Auditor will identify discrepancies, potential fraud, and areas for process improvement, thereby safeguarding the organization's financial health and reputation. By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors. Ultimately, this role supports the delivery of efficient and ethical services by maintaining transparent and accountable claims operations.

Minimum Qualifications:

  • Bachelor’s degree in Health Administration, or a related field.
  • At least 2 years of experience in claims auditing, health care compliance, or a similar role within the health care industry.
  • Strong knowledge of health care claims processes, insurance billing, and regulatory requirements such as HIPAA and CMS guidelines.
  • Proficiency in audit software and Microsoft Office Suite, particularly Excel for data analysis.
  • Relevant experience may substitute for the educational requirement on a year-for-year basis.

Preferred Qualifications:

  • Master’s degree in Health Administration, or a related field.
  • Certification such as Certified Internal Auditor (CIA), Certified Professional Coder (CPC), or Certified Healthcare Auditor (CHA).
  • Experience with claims management software.
  • Familiarity with fraud detection techniques and health care fraud prevention programs.
  • Demonstrated ability to lead audit projects or mentor junior auditors.

Responsibilities:

  • Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
  • Conduct detailed audits of healthcare claims to ensure accuracy, compliance with regulations, and adherence to organizational policies.
  • Analyze claim data and documentation to identify errors, inconsistencies, or potential fraud.
  • Prepare comprehensive audit reports with findings, recommendations, and corrective actions for management and stakeholders.
  • Collaborate with claims teams and healthcare providers to resolve discrepancies and drive process improvements.
  • Stay updated on healthcare regulations and industry best practices, while supporting internal and external audits with relevant documentation and insights.
  • Perform other duties as assigned.



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